Local Solutions to National Change Ken Eason The Bayswater Institute 9 Orme Court London W2 4RL Emeritus Professor Loughborough University

The NPfIT Strategy The aim Shared electronic healthcare records across England in order to improve the co-ordination of healthcare delivery The plan Standard, inter-operable systems used by all Trusts delivered by a small number of consortia The implementation Roll-out across all Trusts in a 10 year period Replacing existing systems Trusts to pay local implementation costs

Implications for the Trusts CfH Suppliers Diversity of Trusts Type Size Healthcare Practices Installed technical systems Location

Problems as Trust’s assimilate NPfIT applications Issue Royal Marsden Care Records will not support research London Mental Health Trusts Care records not fit for mental health - interim system needed St. Mary, Sidcup Slow system delaying patient care Wirrell New system means a step back in sharing records Nuffield Orthopaedic Out patient records lost West Midlands Smartcards not usable in A&E

Jonathan Michael ‘one size fits all’

Two local requirements Recognising diversity tailoring systems to meet local needs Recognising it is a sociotechnical change and not just a technical change developing local working practice to use the technology for better healthcare

A ‘local sociotechnical systems design’ strategy Turning ‘push’ into ‘pull’ Treat IT implementation as a sociotechnical design process The work practice implications are not fixed: local design opportunities Exploit the flexibility of the technical systems for local customisation Help local staff to: identify specific benefits they can realise (develop a ‘pull’) work out a local design plan to realise the local benefits/minimise the costs and risks find an evolutionary path to achieve progressive exploitation of new technical capability Eason K.D. (2005) ‘Exploiting the potential of the NPfIT: a local design approach’ BJHC&IM 22.7 14-16

Sociotechnical issues to address when implementing electronic healthcare records Matching the records to the healthcare practice Collecting data from patients at source Including unstructured clinical data Changing roles and responsibilities Matching access rules to working practice e.g. how to support team work?

Implementation Practices What is needed? Local Sociotechnical design Focus on creating ‘transitional opportunities’ to experiment with new healthcare practices Participation of all stakeholders Evolutionary development of new ways of working What is in place? Change Management Rapid ‘roll out’ Technical implementation ‘Good practice’ in electronic records usage Limited support for the adoption of new working practices

Local sociotechnical design within the current programme Some opportunities but: Technical system constraints Beliefs about ‘good practice’ Rapid implementation limits local design work Focus on technical installation

National programmes and sociotechnical design: The way forward? Technical design: ‘minimum critical specification’ Protocols for sharing data Local organisations to select suppliers Local ‘sociotechnical change’ teams to include all stakeholders Create opportunities for learning and experimentation Recognise and support emergent behaviour and evolution of new working practice